A policy of no post-operative follow-op: passing on the morbidity?
Our department operates a policy of no routine post-operative follow-up for minor and intermediate procedures. This policy is consistent with many other units across the UK. Such a policy has been shown to be cost effective, both for hospital and primary care (Bailey et al 1999). However patients may feel that they wish to see their surgeon post-operatively and general practitioners have expressed concerns that such a policy will increase their workload (Bailey et al 1999, Harle et al 2009).
We conducted an email survey to gauge the feeling of GPs in Perth and Kinross towards this policy. 62% of respondents either agreed or strongly agreed that this policy has increased their workload. The most common procedures that patients consulted their GP post-operatively for were hernia repairs (74%), laparoscopic cholecystectomy (50%) and perianal procedures (39%). Post-operative pain (69%) and wound infection (56%) were common complaints, however 72% of respondents stated that they had to offer regular post-operative advice and explanation of further care.
Encouragingly 68% of GPs felt either confident or very confident in dealing with these complications. When faced with a complication that they were not comfortable with, 44% would make an outpatient referral, 39% would seek telephone advice with 23% making a referral to the on-call team. Of course the action taken will depend on the complication faced. When asked if an open access clinic for post-operative complication would be of benefit, 80% felt that it would.
Our results show suggest that the policy of no follow-up is having an impact on our primary care colleagues, and that there may be a degree of morbidity that we are not be aware of. This has obvious implications for personal audit and quality control. It also highlights the importance of timely and accurate discharge information being communicated to GPs, so that appropriate and informed clinical decisions can be made.
|Mr Russell Mullen||Dr Christopher Wooton||Mr Greig Murray.|
|Specialist Registrar||Foundation Doctor||Consultant Surgeon|
1: Bailey J, Roland M, Roberts C (1999). Is follow up by specialist routinely needed after elective surgery? A controlled trial. J Epidemiol Community Healt; 53: 118-124.
2: Harle D, Ilyas S, Darrah C, Tucker K, Donell S (2009). Community-based orthopaedic follow-up. Is it what doctors and patients want? Ann R Coll Surg Eng; 91: 66-70.
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